Home  About us  Contact
 

Febrile Infants (febrile + infant)

Distribution by Scientific Domains
Medical Sciences90%

Selected Abstracts

Serious Bacterial Infection in Recently Immunized Young Febrile Infants

ACADEMIC EMERGENCY MEDICINE, Issue 12 2009
Margaret Wolff MD
Abstract Objective:, The objective of this study was to investigate the prevalence of serious bacterial infection (SBI) in febrile infants without a source aged 6,12 weeks who have received immunizations in the preceding 72 hours. Methods:, The authors conducted a medical record review of infants aged 6,12 weeks with a fever of ,38.0°C presenting to the pediatric emergency department (ED) over 88 months. Infants were classified either as having received immunizations within the 72 hours preceding the ED visit (recent immunization [RI]) or as not having received immunizations during this time period (no recent immunization [NRI]). Primary outcome of an SBI was based on culture results; only patients with a minimum of blood and urine cultures were studied. Results:, A total of 1,978 febrile infants were studied, of whom 213 (10.8%) had received RIs. The overall prevalence of definite SBI was 6.6% (95% confidence interval [CI] = 5.5 to 7.7). The prevalence of definite SBI in NRI infants was 7.0% (95% CI = 5.9 to 8.3) compared to 2.8% (95% CI = 0.6 to 5.1) in the RI infants. The prevalence of definite SBI in febrile infants vaccinated in the preceding 24 hours decreased to 0.6% (95% CI = 0 to 1.9). The prevalence of definite SBI in febrile infants vaccinated greater than 24 hours prior to presentation was 8.9% (95 CI = 1.5 to 16.4). The relative risk of SBI with RI was 0.41 (95% CI = 0.19 to 0.90). All SBIs in the RI infants were urinary tract infections (UTI). Conclusions:, Among febrile infants, the prevalence of SBI is less in the initial 24 hours following immunizations. However, there is still a substantial risk of UTI. Therefore, urine testing should be considered in febrile infants who present within 24 hours of immunization. Infants who present greater than 24 hours after immunizations with fever should be managed similarly to infants without RIs. [source]

Serious Bacterial Infections in Febrile Infants in the Post,Pneumococcal Conjugate Vaccine Era

ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
Sherri L. Rudinsky MD
Abstract Objectives:, The objective was to identify the epidemiology of serious bacterial infections (SBI) and the current utility of obtaining routine complete blood counts (CBC) and blood cultures to stratify infants at risk of SBI, in the study population of febrile infants in the post,heptavalent pneumococcal conjugate vaccine (PCV7) era. Methods:, A cohort study with nested case-controls was undertaken at a tertiary care military hospital emergency department (ED) from December 2002 through December 2003. Irrespective of clinical findings at the initial encounter, patients were included if they were under 3 months of age and had a home or ED temperature of ,100.4°F or if they were between 3 and 24 months of age with a temperature of ,102.3°F. Data abstracted included age, temperature, peripheral white blood cell (WBC) count, and discharge diagnosis. Culture (blood, urine, and cerebrospinal fluid [CSF]) and chest radiograph (CXR) results were obtained through review of the electronic hospital archives. SBI was defined as pneumonia, urinary tract infection (UTI), meningitis, or bacteremia. Results:, A total of 985 children aged 0 to 24 months were enrolled. Fifty-five percent were male, the median age was 12 months (interquartile range = 8,17 months), and 79% had received at least one PCV7. A total of 132 cases of SBI were identified in 129 infants (13.1%): 82 pneumonias, 45 UTI, five bacteremias, and no cases of bacterial meningitis. The frequency of bacteremia was 0.7%. No statistical difference was detected in the WBC count between the SBI and non-SBI groups (13.8 ± 5.8 and 11.7 ± 5.6, respectively; p = 0.055). No readily available WBC cutoff on the receiver operating characteristic (ROC) curve proved to be an accurate predictor of SBI. No statistical difference was detected in mean temperature between the SBI and non-SBI groups (103.3 ± 1.2 and 103.2 ± 1.2°F, respectively; p = 0.26), nor was there a difference noted when groups were broken down by age or height of fever. Conclusions:, The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era. [source]

Risk of Serious Bacterial Infection in Isolated and Unsuspected Neutropenia

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Elliot Melendez MD
ACADEMIC EMERGENCY MEDICINE 2010; 17:1,5 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to determine the risk of serious bacterial infection (SBI) among children without underlying risk factors for SBI who present to the emergency department (ED) for evaluation and have unsuspected and isolated neutropenia. Methods:, This was a retrospective consecutive chart review from October 1995 through September 2003. All patients aged 0,21 years presenting to the ED of an urban tertiary children's hospital, who were documented to have neutropenia (defined as an absolute neutrophil count [ANC] of <1,000 cells/,L) without known underlying risk factor for SBI were eligible for inclusion. SBI was defined as growth of a pathogen from culture of blood, urine, or cerebrospinal fluid (CSF). Results:, There were 3,179 children with an ANC of <1,000/,L during the study period. Of these, 1,888 had no underlying immunodeficiency or central venous catheter (CVC). Fifteen of 453 (3.3%; 95% confidence interval [CI] = 1.9% to 5.4%) infants less than 3 months of age had SBI: seven with bacteremia, four with meningitis, and eight with urinary tract infections. SBI was rare among children over 3 months of age (18 of 1,435; 1.3%; 95% CI = 0.7% to 2.0%): one had bacteremia, none had meningitis, and 13 had urinary tract infections. Conclusions:, Children older than 3 months of age without underlying immunodeficiency or CVC presenting to the ED and unexpectedly found to have isolated neutropenia are not at high risk of SBI. Infants less than 3 months of age have similar risk of SBI as febrile infants of same age. [source]

Predominant human herpesvirus 6 variant A infant infections in an HIV-1 endemic region of Sub-Saharan Africa

JOURNAL OF MEDICAL VIROLOGY, Issue 5 2009
Matthew Bates
Abstract Human herpesvirus 6, HHV-6, commonly infects children, causing febrile illness and can cause more severe pathology, especially in an immune compromised setting. There are virulence distinctions between variants HHV-6A and B, with evidence for increased severity and neurotropism for HHV-6A. While HHV-6B is the predominant infant infection in USA, Europe and Japan, HHV-6A appears rare. Here HHV-6 prevalence, loads and variant genotypes, in asymptomatic compared to symptomatic infants were investigated from an African region with endemic HIV-1/AIDS. DNA was extracted from blood or sera from asymptomatic infants at 6 and 18 months age in a population-based micronutrient study, and from symptomatic infants hospitalised for febrile disease. DNA was screened by qualitative and quantitative real-time PCR, then genotyped by sequencing at variable loci, U46 (gN) and U47 (gO). HIV-1 serostatus of infants and mothers were also determined. HHV-6 DNA prevalence rose from 15% to 22% (80/371) by 18 months. At 6 months, infants born to HIV-1 positive mothers had lower HHV-6 prevalence (11%, 6/53), but higher HCMV prevalence (25%, 17/67). HHV-6 positive febrile hospitalized infants had higher HIV-1, 57% (4/7), compared to asymptomatic infants, 3% (2/74). HHV-6A was detected exclusively in 86% (48/56) of asymptomatic HHV-6 positive samples genotyped. Co-infections with both strain variants were linked with higher viral loads and found in 13% (7/56) asymptomatic infants and 43% (3/7) HIV-1 positive febrile infants. Overall, the results show HHV-6A as the predominant variant significantly associated with viremic infant-infections in this African population, distinct from other global cohorts, suggesting emergent infections elsewhere. J. Med. Virol. 81:779,789, 2009. © 2009 Wiley-Liss, Inc. [source]

Serious Bacterial Infection in Recently Immunized Young Febrile Infants

ACADEMIC EMERGENCY MEDICINE, Issue 12 2009
Margaret Wolff MD
Abstract Objective:, The objective of this study was to investigate the prevalence of serious bacterial infection (SBI) in febrile infants without a source aged 6,12 weeks who have received immunizations in the preceding 72 hours. Methods:, The authors conducted a medical record review of infants aged 6,12 weeks with a fever of ,38.0°C presenting to the pediatric emergency department (ED) over 88 months. Infants were classified either as having received immunizations within the 72 hours preceding the ED visit (recent immunization [RI]) or as not having received immunizations during this time period (no recent immunization [NRI]). Primary outcome of an SBI was based on culture results; only patients with a minimum of blood and urine cultures were studied. Results:, A total of 1,978 febrile infants were studied, of whom 213 (10.8%) had received RIs. The overall prevalence of definite SBI was 6.6% (95% confidence interval [CI] = 5.5 to 7.7). The prevalence of definite SBI in NRI infants was 7.0% (95% CI = 5.9 to 8.3) compared to 2.8% (95% CI = 0.6 to 5.1) in the RI infants. The prevalence of definite SBI in febrile infants vaccinated in the preceding 24 hours decreased to 0.6% (95% CI = 0 to 1.9). The prevalence of definite SBI in febrile infants vaccinated greater than 24 hours prior to presentation was 8.9% (95 CI = 1.5 to 16.4). The relative risk of SBI with RI was 0.41 (95% CI = 0.19 to 0.90). All SBIs in the RI infants were urinary tract infections (UTI). Conclusions:, Among febrile infants, the prevalence of SBI is less in the initial 24 hours following immunizations. However, there is still a substantial risk of UTI. Therefore, urine testing should be considered in febrile infants who present within 24 hours of immunization. Infants who present greater than 24 hours after immunizations with fever should be managed similarly to infants without RIs. [source]

Serious Bacterial Infections in Febrile Infants in the Post,Pneumococcal Conjugate Vaccine Era

ACADEMIC EMERGENCY MEDICINE, Issue 7 2009
Sherri L. Rudinsky MD
Abstract Objectives:, The objective was to identify the epidemiology of serious bacterial infections (SBI) and the current utility of obtaining routine complete blood counts (CBC) and blood cultures to stratify infants at risk of SBI, in the study population of febrile infants in the post,heptavalent pneumococcal conjugate vaccine (PCV7) era. Methods:, A cohort study with nested case-controls was undertaken at a tertiary care military hospital emergency department (ED) from December 2002 through December 2003. Irrespective of clinical findings at the initial encounter, patients were included if they were under 3 months of age and had a home or ED temperature of ,100.4°F or if they were between 3 and 24 months of age with a temperature of ,102.3°F. Data abstracted included age, temperature, peripheral white blood cell (WBC) count, and discharge diagnosis. Culture (blood, urine, and cerebrospinal fluid [CSF]) and chest radiograph (CXR) results were obtained through review of the electronic hospital archives. SBI was defined as pneumonia, urinary tract infection (UTI), meningitis, or bacteremia. Results:, A total of 985 children aged 0 to 24 months were enrolled. Fifty-five percent were male, the median age was 12 months (interquartile range = 8,17 months), and 79% had received at least one PCV7. A total of 132 cases of SBI were identified in 129 infants (13.1%): 82 pneumonias, 45 UTI, five bacteremias, and no cases of bacterial meningitis. The frequency of bacteremia was 0.7%. No statistical difference was detected in the WBC count between the SBI and non-SBI groups (13.8 ± 5.8 and 11.7 ± 5.6, respectively; p = 0.055). No readily available WBC cutoff on the receiver operating characteristic (ROC) curve proved to be an accurate predictor of SBI. No statistical difference was detected in mean temperature between the SBI and non-SBI groups (103.3 ± 1.2 and 103.2 ± 1.2°F, respectively; p = 0.26), nor was there a difference noted when groups were broken down by age or height of fever. Conclusions:, The WBC count and height of fever were not found to be accurate predictors of SBI in infants age 3 to 24 months. UTI and pneumonias made up the vast majority of SBI in this population of infants. The overall bacteremia frequency was well below 1%. This calls into question the continued utility of obtaining routine complete cell counts and blood cultures in the febrile infant in the post-PCV7 era. [source]

Should complete blood count be part of the evaluation of febrile infants aged ,2 months?

ACTA PAEDIATRICA, Issue 9 2010
Efraim Bilavsky
ABSTRACT Objective:, To determine the utility and importance of total white blood cell count (WBC) and absolute neutrophil count (ANC) as markers of serious bacterial infection (SBI) in hospitalized febrile infants aged ,2 months. Patients and methods:, Data on WBC and ANC were collected prospectively for all infants aged ,2 months who were hospitalized for fever at our centre. The patients were divided into two groups by the presence or absence of SBI. Results:, A total of 1257 infants met the inclusion criteria, of whom 134 (10.7%) had a SBI. The area under the ROC curve was 0.73 (95% CI: 0.67,0.78) for ANC, 0.70 (95% CI: 0.65,0.76) for %ANC and 0.69 (95% CI: 0.61,0.73) for WBC. The independent contribution of these three tests in reducing the number of missed cases of SBI was significant. Conclusion:, Complete blood cell count should remain as part of the routine laboratory assessment in this age group as it is reducing the number of missing infants with SBI. Of the three parameters, ANC and %ANC serve as better diagnostic markers of SBI than total WBC. However, more accurate tests such as C-reactive protein and procalcitonin should also be part of the evaluation of febrile infants in these age group as they perform better than WBC or ANC for predicting SBI. [source]

C-reactive protein as a marker of serious bacterial infections in hospitalized febrile infants

ACTA PAEDIATRICA, Issue 11 2009
Efraim Bilavsky
Abstract Objective:, To determine the potential predictive power of C-reactive protein (CRP) as a marker of serious bacterial infection (SBI) in hospitalized febrile infants aged ,3 months. Patients and Methods:, Data on blood CRP levels were collected prospectively on admission for all infants aged ,3 months who were hospitalized for fever from 2005 to 2008. The patients were divided into two groups by the presence or absence of findings of SBI. Results:, A total of 892 infants met the inclusion criteria, of whom 102 had a SBI. Mean CRP level was significantly higher in the infants who had a bacterial infection than in those who did not (5.3 ± 6.3 mg/dL vs. 1.3 ± 2.2 mg/dL, p < 0.001). The area under the ROC curve (AUC) was 0.74 (95% CI: 0.67,0.80) for CRP compared to 0.70 (95% CI: 0.64,0.76) for white blood cell (WBC) count. When analyses were limited to predicting bacteremia or meningitis only, the AUCs for CRP and WBC were 0.81 (95% CI: 0.66,0.96) and 0.63 (95% CI: 0.42,0.83), respectively. Conclusion:, C-reactive protein is a valuable laboratory test in the assessment of febrile infants aged ,3 months old and may serve as a better diagnostic marker of SBI than total WBC count. [source]